INDIVIDUAL EDUCATION PROGRAM

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STUDENT NAME: Sarah Smith SIMS:

PARENT/GUARDIAN NAME: Sam and Sally Smith PHONE: 605-555-5555
ADDRESS: 555 W. 1st Street Aberdeen SD, 57401 WK PHONE: 605-555-5556
SCHOOL DISTRICT: Aberdeen School District SCHOOL: Lincoln Elementary
DOB: January 17, 2010 AGE: 7 years 10 months GRADE: 2nd
GENDER: Female RACE: Caucasian

Meeting Date: 10/17/2017 Purpose of Meeting

☐ Initial Eligibility, IEP, Placement
Date Services Begin: 10/18/2017
☒ Annual Review of IEP
Annual Review Date: 10/17/2018
☐ Three Year Reevaluation
Date of Eligibility Determination: 10/20/2016 ☐ Dismissal from Services - Date Effective:
☐ Parent Request
Three Year Reevaluation Due By: 10/20/2019
☐ Other:

Discussed evaluation results/progress/assessment
method ☒ Yes
SS (Parent/Guardian initial)
Copy of evaluation results received ☒ Yes
SS (Parent/Guardian initial)
Transition Planning Needed ☒ No ☐ Yes
(*If yes, attach applicable transition pages.)
Student is eligible for special education or special education
and related services as determined by the IEP team
☒ Yes ☐ No
An annual copy of Parent/Guardian Rights was received and
reviewed
10/05/2017 (Date) SS (Parent/Guardian Initial)
A copy of the IEP was provided to parent/guardian ☒ Yes
SS (Parent/Guardian Initial)

Primary Disability: Specific Learning Disabilities

IEP Team Membership Signature Date

Parent/Guardian Sam Smith 10/17/17
Parent/Guardian Sally Smith 10/17/17
Student Sarah Smith 10/17/17
School Representative Jen Loft 10/17/17
General Education Teacher Krista Beauregard 10/17/17
Special Education Teacher or Provider Catherine Leber 10/17/17
Speech/Language Pathologist Vicki Evansworth 10/17/17
Individual who can interpret evaluation results Dr. Tim Downs 10/17/17
Other: Behavior Specialist (by request of parents) Rachel Wolf 10/17/17
Other:
Other:

South Dakota Department of Education Page |1 Revised – July 2014

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Present Levels of Academic Achievement and Functional Performance

In developing each student’s IEP, the IEP Team must consider 1) the strengths of the student; 2) the concerns of the
parents for enhancing the education of their student; 3) the results of the initial or most recent evaluation of the student;
and 4) the academic, developmental, and functional needs of the student.

Provide a statement of the student’s present levels of academic achievement and functional performance, including 1)
how the student’s disability affects the student’s involvement and progress in the general education curriculum (i.e.,
the same curriculum as for nondisabled students); or 2) for preschool students, as appropriate, how the disability affects
the student’s participation in appropriate activities.

Sarah interacts well with peers and authority figures. She does well with following agreed upon rules in class
discussions, listening, and participating in class. However, Sarah tends to get frustrated while working on reading
because she cannot read at the same level as her peers. At this time, when Sarah is frustrated, she exhibits
inappropriate behavior including refusing to comply with directions, and she gets aggressive by pushing her books off
her desk. One of her needs is that she needs to learn techniques to help her stay calm in those situations and find
better outlets for her frustration. Her oral language skills are age appropriate, and her overall intellectually ability is
average.

For ELA, Sarah’s strengths include the areas of speaking and listening as well as some areas in writing. Sarah can
tell a story that includes setting, problem, action, and conclusion. She can write in complete sentences using
inventive spelling, she is at the pre-phonetic level, and her sentences are logically sequenced. In the subjects of
reading and language, Sarah is behind her classmates. She has the sight vocabulary of 50 words when a typical
second grader has 150, and she can decode words that include certain letters. Her fluency level, which is something
that needs to be improved, is 30 words per minute while the expected rate is around 80 words per minute.

She is able to spell Consonant-Vowel-Consonant words with vowel sounds /a/. The 2nd grade objective for students
in the general education classroom is that students will be able to spell CVC and CVCe words with all vowel sounds;
so, one of her needs will be to working on getting to that level. On her spelling CBM, Sarah could spell 26 letter
sequences correctly where the expectation for a typical 2 nd grader is around 49 correct letter sequences. Her
parents’ biggest concerns are in the area of reading and how it will affect her as she continues in school to other
subjects.

Sarah is performing at or above grade level in math when the problems are read to her, but when she is to do the
problems by herself, the reading difficulty impacts her results. On the MCAP (CBM), she scored in the 10-25th
percentile getting only 2 right when the expected level is 6 correct. But on her MCOMO (CNM), Sarah was able to
correctly score 18 addition and subtraction items when the expected level is 16.

* Remember to address:
 Strengths & needs using academic achievement (skill based assessment) AND functional performance
 Transition strengths and needs including the student’s preferences and interests (must be in the student’s IEP by age 16)

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Consideration of Special Factors

Is the student limited English proficient? ☐ Yes ☒ No
If the answer to this question is “yes”, please explain the language needs of the student as these needs relate to the
student’s IEP.

Are there any special communication needs? ☐ Yes ☒ No

If the answer to this question is “yes”, please explain the communication needs of the student, and in the case of a
student who is deaf or hard of hearing, consider the student’s language and communication needs, opportunities for direct
communications with peers and professional personnel in the student’s language and communication mode, academic
level, and full range of needs, including opportunities for direct instruction in the student’s language and communication
mode.

Does the student require Braille? ☐ Yes ☒ No

If the answer to this question is “yes”, what instruction in Braille and use of Braille will be provided?

Does the student’s behavior impede his or her learning or that of others? ☐ Yes ☒ No
If yes, what strategies are required to appropriately address this behavior, including positive behavioral interventions and
supports?

Does the student require Assistive Technology Devices and Services? ☐ Yes ☒ No
If yes, what device or service will be provided?

Physical Education: ☒ Regular ☐ Not Required ☐ Adaptive:

Refer to Goals/Goals & Objectives

Hearing Aid Maintenance: ☒ Not Applicable ☐ Yes: Personnel Responsible for Monitoring:
Describe the monitoring process/frequency necessary for maintenance:

Assessment
☒ Student will be taking state and district-wide assessments with or without accommodations.

☐ Student will be taking state and district-wide alternate assessments (The alternate assessment is for students working
in the alternate achievement standards) (Annual goal and short term objectives required)
a. Does the student meet the significant cognitive disability criteria? (If no, student is not eligible to take the
alternate assessment) ☐ Yes ☐ No
b. Explain the reason why the student cannot participate in the regular assessment.

c. Explain the reason why the alternate assessment selected is appropriate for this student.

☐ No state and/or district-wide assessments are required at this student’s grade level during the course of this annual
IEP.

South Dakota Department of Education Page |3 Revised – July 2014

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Educational Goals and Objectives/Benchmarks

Provide a statement of measurable annual goals, including academic and functional goals designed to 1) meet the student’s
needs that result from the disability, 2) enable the student to be involved in and make progress in the general education
curriculum, and 3) meet each of the student’s other educational needs that result from the disability.

Measurable Annual Goal # 1

When given a story at a 2nd grade level, Sarah can Proc. Date Prog. Comments:
read at a fluency rate of 50 words per minute from Code/s Code
the current level of 30 words per minute with an 8
accuracy of 4 out of 5 times.

Measurable Annual Goal # 2

When frustrated while working on skills she 2
struggles with, Sarah will use appropriate
techniques to calm herself down within a 5-minute
break with an accuracy rate of 90%.

Measurable Annual Goal # 3

When given CVC words with various vowel sounds,
1
Sarah will be able to spell the words with an
accuracy rate of 90%.compared to her current level 6
of just vowel sound /a/.
8

Measurable Annual Goal #

Procedure Codes (Complete at IEP meeting) Progress Codes Reporting Frequency to Parents
1. Teacher-made tests 6. Work Samples P= Progress being made ☒ Quarterly Reports
2. Observations 7. Portfolios I= Insufficient Progress to meet goal ☐ Trimester Reports ☐ Other:
3. Weekly tests 8. Oral Tests X= Not addressed this Reporting Period Reporting Method to Parents
4. Unit tests 9. Data Response M=Met goal
☐ Conferences ☒ Report Card
5. Student Conferences 10. Other:
☐ Goal Page Copy ☐ Other:

South Dakota Department of Education Page |4 Revised – July 2014

 INDIVIDUAL EDUCATION PROGRAM
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Educational Goals and Objectives/Benchmarks

Provide a statement of measurable annual goals, including academic and functional goals designed to 1) meet the student’s
needs that result from the disability, 2) enable the student to be involved in and make progress in the general education
curriculum, and 3) meet each of the student’s other educational needs that result from the disability.

Measurable Annual Goal #

Proc. Date Prog. Comments:
Code/s Code

Short Term Instructional Objectives or Benchmarks Proc. Date Prog. Comments:

(Required for students who take alternate Code/s Code
assessment.)

Procedure Codes (Complete at IEP meeting) Progress Codes Reporting Frequency to Parents
1. Teacher-made tests 6. Work Samples P= Progress being made ☐ Quarterly Reports
2. Observations 7. Portfolios I= Insufficient Progress to meet goal ☐ Trimester Reports ☐ Other:
3. Weekly tests 8. Oral Tests X= Not addressed this Reporting Period Reporting Method to Parents
4. Unit tests 9. Data Response M=Met goal ☐ Conferences ☐ Report Card
5. Student Conferences 10. Other: ☐ Goal Page Copy ☐ Other:

South Dakota Department of Education Page |5 Revised – July 2014

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Accommodations and Modifications

Accommodations/Modifications/Supplementary Aides and Frequency Location Duration

Services
1. Sarah will be allowed to have tests read aloud to her. Daily Special Length of the
2. Sarah will be allowed to take two 5-minute breaks per Daily Education IEP
hour while working on language arts or reading to prevent Daily Classroom Length of the
behavioral issues. General IEP
3. When working on math, social studies, and science Education Length of the
homework, Sarah will be able to go to the special Classroom IEP
education room to have her problems read aloud to her. Special
4. Education
Classroom

Statement of the program modifications or supports for Frequency Location Duration

school personnel (as appropriate):

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State/District-wide Assessment Accommodations

☐ Student will be taking the assessment without accommodations.

☒ Student will be taking the assessment with the accommodations.

*Teams must consider if the accommodations are approved for the applicable test administration.

*List the accommodations the student will be taking for each test/test area.
(Only those accommodations identified for instruction on the goal pages can be considered for state and district-wide
testing. The accommodations selected for use must relate to the student’s disability.)

State Assessment Accommodations

Smarter Balanced Smarter Balanced Dakota STEP

ELA (Gr 3-8 & 11): Math (Gr 3-8 & 11): Science (Gr 5, 8 & 11):
Read Aloud (Not incl. Rdg Passages) Read Aloud 6. Read Aloud
_____________ _____________ _____________
_____________ _____________ _____________
_____________ _____________ _____________
_____________ _____________ _____________

Test: Test: Test:

* NSCS Alt Assessment and D-STEP Alt Science

Accommodations for both instruction and assessment must be documented.

District-wide Assessment Accommodations

Test: Test: Test:

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Special Education Services

Description of services Frequency Location Duration

Reading Fluency 30 minutes-3 times a week Resource Room Length of the IEP
Social Skills Training 15 minutes daily Resource Room Length of the IEP
Spelling Instruction 30 minutes-2 times a week Resource Room Length of the IEP

Related Service to be Provided Frequency Location Duration

☐ Speech/Language Therapy
☐ Occupational Therapy
☐ Physical Therapy
☐ Transportation (Specify when, how
often, where, distance, costs, etc.)
☐ Counseling Services
(Including rehabilitation counseling)
☐ Audiological Services
☐ Interpreting Services
☐ Medical Services
(Diagnostic Services only)
☐ Orientation and Mobility
☐ Parent Counseling/Training
☐ Psychological Services
☐ Recreation Therapy
☐ School Nurse/Health Services
☐ Social Work Services (in schools)
☐ Other

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Least Restrictive Environment

The IEP Team must ensure that, to the maximum extent appropriate, students with disabilities are educated with
nondisabled peers, including extracurricular services and activities.

Continuum of Alternative Placements Continuum of Alternative Placements (Ages 3-5)

☒ 0100 General Classroom with Modifications 80-100% ☐ 0310 Early Childhood Setting-10 hrs.+/week
services in Reg EC program
☐ 0110 Resource Room 40-79%
☐ 0315 Early Childhood Setting-10 hrs.+/week
☐ 0120 Self-Contained Classroom 0-39%
services in other location
☐ 0130 Separate Day School
☐ 0325 Early Childhood Setting-Less than 10hrs/wk.
☐ 0140 Residential Facility services in Reg EC program
☐ 0150 Home/Hospital ☐ 0330 Early Childhood Setting-Less than 10hrs/wk.
services in other location
☐ 0335 Special Education Class
☐ 0345 Separate School
☐ 0355 Residential Facility
☐ 0365 Home
☐ 0375 Service Provider Location

Participation with Non-Disabled Peers

Program Options Non-Academic Extracurricular
☒ Art ☒ Counseling ☒ Athletics
☒ Industrial Technology ☒ Meals ☒ Clubs
☒ Music ☒ Employment Referrals ☒ Groups
☒ Vocational Education ☒ Recess ☒ Recreation
☒ Family & Consumer Science ☒ Health Services ☐ Other
☐ Other ☐ Other

Comments:

Justification for Placement--An explanation of the extent, if any, to which the student will not participate with
non-disabled students in regular classes and non-academic activities.
(Please use accept/reject format for each alternative placement considered.)
Sarah is placed in the general education classroom for the majority of the day only being taken out for additional
assistance to what she is learning in the special education classroom. With Sarah being allowed “brain breaks”
throughout her time working, she is able to better work on her homework without getting frustrated which allows her to
spend more time with her non-disabled peers. To help her eventually get up to the level of her peers, Sarah is in need
of special reading instruction that will happening in the resource room. When working on homework or tests for other
classes besides reading, Sarah will have the tests read to her as the reading of the questions is what deters her scores
on those exams unless read aloud to her. This service will be provided in the resource room so that Sarah has a quiet
and non-distracting environment to work to her best ability.

☐ The team addressed the potential harmful effects of the special education placement.

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Extended School Year

Extended School Year Services: ☐ needed ☐ not needed ☒ to be determined by (Date) 04/15/18

Beginning Date Ending Date Minutes

Goal(s) # *Type of Service **Based on
mm/dd/yy mm/dd/yy Per Week

* Instruction, related services (specify), other (list)

** Regression/Recoupment, Emerging Skills, or Maintenance of Critical Life Skills

South Dakota Department of Education P a g e | 10 Revised – July 2014